Wiki Basic MRI & MRA

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MSimmons89

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Hello,

I am currently the billing and coding specialist for a chiropractic/pain management office. We recently opened an MRI center and outsourced that billing to a company upstate. They are doing a horrible job, several denials and minimal reimbursement. I'm trying to do some research to take over the billing for our MRI center but can not seem to find any help.

If there is anyone who can mentor me or give me any help with the billing guidelines for MRI, I cannot tell you how much I would appreciate it! Our chiro/pain mgmt office has been floating the cost for the imaging center since August and it's killing us. This billing company is useless so I guess if you want something done right, you have to do it yourself! Thanks so much for any and all your help!
 
MSimmons89 said:
Hello,

I am currently the billing and coding specialist for a chiropractic/pain management office. We recently opened an MRI center and outsourced that billing to a company upstate. They are doing a horrible job, several denials and minimal reimbursement. I'm trying to do some research to take over the billing for our MRI center but can not seem to find any help.

If there is anyone who can mentor me or give me any help with the billing guidelines for MRI, I cannot tell you how much I would appreciate it! Our chiro/pain mgmt office has been floating the cost for the imaging center since August and it's killing us. This billing company is useless so I guess if you want something done right, you have to do it yourself! Thanks so much for any and all your help![/QUOTE

First question - are you billing Medicare? If so, did you get the center accredited under ADI by one of the 3 accrediting agencies?
Is this an IDTF? Did you list all the MRI codes when you got accredited for that?
What denial reasons are you getting? Are the exams pre-authorized? Are you billing globally, or just the technical?
Click to expand...
 
We are billing Medicare and are accredited through ACR, we are an IDTF. As far as denial codes and such, the billing company we are using are not sending us the EOB's from the funds we do receive. I have been requesting them to forward copies to us but they are very reluctant to do so.

I know of the denials because I called Medicare's automated line for claim status to find out all of the claims were denied and then resubmitted again. I understand room for error, but since they are a billing company I would not expect denials for the wrong use of a modifier.

We are pre-certing insurance that we need to (BCBSIL, Healthlink, etc.) so I am pretty confident that the problems is with the billing agency. But like I said, they are very reluctant to send me copies of the eob's so I am in the dark right now. Thank you for helping!
 
The guidelines are pretty basic - if billing globally, do not add a modifier, if billing technical only, use TC, and if billing professional only use -26.
It should be the exception, rather than the rule to code both an MRI and an MRA of the same body area. If you do, one of them will need a -59 modifier (check CCI). MRA has limited coverage under CMS, and some contractors have limited coverage for MRI although there is more coverage. MRA is now considered part of MRI, so there may be one combined LCD instead of 2 separate ones.
If you are billing for the facility and provide the gadolinium, also code the appropriate A code (A9576-A9579, A9581, A9583, A9585).
MRA is MR "angiography", not "arteriography" and it includes arterial imaging, or venous imaging, or both. Do not code the MRA code twice for MRA and MRV of the same body area.
For Medicare, if you do 2 or more CT, MR, or ultrasound exams, expect reduced payment due to the MPPR.
 
Thanks so much for your help, but what about software? I use Medisoft for chiro/pain mgmt but I don't think that would suffice for MRI. Is there a software you use that you like? Also, are there certain diagnosis to justify a certain area of study? Thanks for being so helpful! :)
 
MSimmons89 said:
Thanks so much for your help, but what about software? I use Medisoft for chiro/pain mgmt but I don't think that would suffice for MRI. Is there a software you use that you like? Also, are there certain diagnosis to justify a certain area of study? Thanks for being so helpful! :)
Click to expand...

Software for billing?
I don't actually do routine coding / billing anymore, I teach, audit, write, sosomeone else will have to discuss software.

Does your state's medicare contractor have an LCD for MRI? That would be the first place to look for diagnoses. If they don't have a current LCD, check to see if they have a retired one. It will give you a good idea of what they are looking for.
Generally, MRI and MRA are not done for the same clinical indication, so routine billing of both is a no-no! Here's what CMS says in the NCCI Policy Manual:
"Similarly magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate MRI and MRA reports, only one procedure, either the MRI or MRA, for the anatomic region may be reported. Both an MRI and MRA may be reported for the same anatomic region if they are performed at separate patient encounters or if two separate and distinct technical studies, one for the MRI and one for the MRA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon."
 
A9585

donnajrichmond said:
The guidelines are pretty basic - if billing globally, do not add a modifier, if billing technical only, use TC, and if billing professional only use -26.
It should be the exception, rather than the rule to code both an MRI and an MRA of the same body area. If you do, one of them will need a -59 modifier (check CCI). MRA has limited coverage under CMS, and some contractors have limited coverage for MRI although there is more coverage. MRA is now considered part of MRI, so there may be one combined LCD instead of 2 separate ones.
If you are billing for the facility and provide the gadolinium, also code the appropriate A code (A9576-A9579, A9581, A9583, A9585).
MRA is MR "angiography", not "arteriography" and it includes arterial imaging, or venous imaging, or both. Do not code the MRA code twice for MRA and MRV of the same body area.
For Medicare, if you do 2 or more CT, MR, or ultrasound exams, expect reduced payment due to the MPPR.
Click to expand...

Do you have a per unit fee that you charge for A9585?
 
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